Special Poster Session 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

Introduction: Lumbar listhesis, a condition characterized by the forward displacement of one vertebra over another, is a common cause of lower back pain and neurological symptoms. While surgical intervention is often required in symptomatic cases, there is ongoing debate regarding the optimal surgical approach for treating single-level listhesis. Laminectomy, aimed at decompressing neural structures, is a widely performed procedure, but whether to combine it with spinal fusion (arthrodesis) remains controversial. While fusion may enhance spinal stability and reduce the risk of recurrence, it is also associated with a higher risk of complications. This study aims to compare the clinical outcomes of laminectomy with arthrodesis versus laminectomy alone in patients with single-level lumbar listhesis, focusing on pain relief, functional recovery, complication rates, and radiologic features.  

Methods: A retrospective analysis was conducted on 45 patients with single-level lumbar listhesis who underwent surgical treatment between November 2018 and October 2023. Patients were divided into two groups: Group A (28 patients) underwent laminectomy with arthrodesis, and Group B (17 patients) underwent laminectomy alone. Within group A, 12 patients had an intersomatic fusion using a cage, whereas 16 has a "classic" fusion. Clinical outcomes were assessed using pain scores (VAS), functional disability (Oswestry Disability Index), and patient satisfaction. Radiologic assessment was performed thourgh X Rays to look for postoperative modifications of the spinal static. Follow-up period ranged from 1 to 4 years. The incidence of perioperative complications and the recurrence of listhesis were also recorded.

Results: A total of 45 patients with single-level lumbar listhesis were analyzed. Group A, consisting of 28 patients who underwent laminectomy with arthrodesis, showed significantly greater improvements in both pain scores (VAS) and functional outcomes (Oswestry Disability Index) compared to Group B (17 patients) who underwent laminectomy alone. Within Group A, patients who received intersomatic fusion using a cage (12 patients) demonstrated slightly better radiologic outcomes, with more stable spinal alignment on follow-up X-rays, compared to those who had classic fusion (16 patients). However, no significant differences in clinical outcomes were observed between the two fusion techniques.

Postoperative complications were more frequent in Group A, with 6 cases of infection and 3 cases of implant-related issues, compared to only 1 minor wound complication in Group B. Despite this, Group A had a lower recurrence rate of listhesis (4%) and fewer reoperations (1 case) compared to Group B, which had a recurrence rate of 18% and 3 cases requiring reoperation.

Overall, the follow-up period ranged from 1 to 4 years, and patient satisfaction was higher in the arthrodesis group, with 85% of patients reporting good to excellent outcomes, compared to 65% in the laminectomy-alone group.

Conclusion: In the treatment of single-level lumbar listhesis, laminectomy with arthrodesis provides superior long-term outcomes in terms of pain relief, functional improvement, and reduced recurrence compared to laminectomy alone. However, the higher complication rate associated with arthrodesis necessitates a careful evaluation of surgical risks and benefits for each patient.